Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia最新文献

{"title":"Zuranolone for postpartum depression: a systematic review and meta-analysis of two randomized studies.","authors":"Juliana Almeida Oliveira, Karine Eskandar, Marcos Aurélio Araújo Freitas, Chris Elizabeth Philip","doi":"10.61622/rbgo/2024rbgo79","DOIUrl":"10.61622/rbgo/2024rbgo79","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the maternal outcomes in women with postpartum depression using zuranolone, the first oral medication indicated to treat postpartum depression.</p><p><strong>Methods: </strong>We conducted a systematic search in September 2023, on Pubmed, Embase and Cochrane Trials. We included randomized controlled trials comparing the effectiveness and safety of zuranolone versus placebo in women with postpartum depression. No time or language restrictions were applied. 297 results were retrieved, of which 11 papers were selected and fully reviewed by two authors. Review Manager 5 was used for statistical analysis and Cochrane Risk-of-bias tool for randomized trials was applied for quality assessment.</p><p><strong>Results: </strong>We included 2 studies, with 346 women, of whom 174 (50.2%) were treated with zuranolone. Zuranolone was significantly associated to an improvement of Clinical Global Impression response rate; Hamilton Depression Rating Scale 15 days and 45-day remission, 3-day, 15-day, and 45-day symptom remission, and reduction in the dose of antidepressants. As for safety outcomes, it was noticed that zuranolone increases sedation risk, which can be dose related. No significant differences were found for other adverse events.</p><p><strong>Conclusion: </strong>These findings suggest that zuranolone might present a safe and effective medication for out-of-hospital treatment of PPD. Sedation effects need to be further assessed.</p>","PeriodicalId":74699,"journal":{"name":"Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia","volume":"46 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognosis and cardiotoxicity associated to adjuvant trastuzumab for breast cancer: real world study in a public health system.","authors":"Ana Elisa Ribeiro da Silva Cabello, César Cabello, Susana Oliveira Botelho Ramalho, Otávio Rizzi Coelho, Otávio Rizzi Coelho-Filho, Helymar da Costa Machado, Délio Marques Conde, Luiz Carlos Zeferino","doi":"10.61622/rbgo/2024rbgo93","DOIUrl":"10.61622/rbgo/2024rbgo93","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the prognosis of patients with breast cancer who developed trastuzumab-induced cardiotoxicity and to analyze factors associated with and resulting from cardiotoxicity.</p><p><strong>Methods: </strong>This was a retrospective cohort study that included 255 HER2-positive breast cancer patients who received adjuvant trastuzumab therapy. The inclusion criteria were a diagnosis of HER2-positive breast cancer and adjuvant trastuzumab therapy; disease stage I-III; <70 years; and a baseline echocardiogram showing a left ventricular ejection fraction (LVEF) ≥ 55%. The Kaplan-Meier method, the log-rank test, and the Cox proportional hazards model were used.</p><p><strong>Results: </strong>In all, 15.3% (39/255) of patients presented with cardiotoxicity. Treatment was suspended in 92.3% (36/39) of patients who presented with cardiotoxicity during trastuzumab treatment. The treatment was suspended in 46 of 255 patients and it was permanently interrupted in 84.8% (33/46) of these patients, with 84.8% (28/33) due to cardiotoxicity. Cardiotoxicity was not associated with disease-free survival (DFS) (hazard ratio (HR) = 1.48; 95% confidence interval (CI = 0.79-2.78) or overall survival (OS) (HR = 1.68; 95%CI= 0.83-3.41). Patients with clinical stage III and whom trastuzumab therapy was suspended (all causes) had worse DFS; (HR = 3.19; 95% CI=1.77-5.74) and (HR = 1.83; 95% CI=1.01-3.32) respectively. Those with clinical stage III and whom trastuzumab therapy was permanently interrupted had worse OS; (HR = 3.80; 95% CI =1.82-7.94), and (HR = 2,26; 95% CI =1.09-4.68 respectively.</p><p><strong>Conclusion: </strong>Cardiotoxicity was not associated with DFS or OS. Clinical stage III, Suspension and permanent interruption of treatment regardless of the cause were associated with worse DFS and OS in breast cancer patients.</p>","PeriodicalId":74699,"journal":{"name":"Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia","volume":"46 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-medication among pregnant women in comparison to the general population: a scoping review of the main characteristics.","authors":"Gabriela Pereira, Cinthia Madeira de Souza, Amanda Canato Ferracini, Fernanda Garanhani Surita, Sherif Eltonsy, Priscila Gava Mazzola","doi":"10.61622/rbgo/2024rbgo77","DOIUrl":"10.61622/rbgo/2024rbgo77","url":null,"abstract":"<p><strong>Objective: </strong>An in-depth evaluation of the published evidence is needed on self-medication, specifically the evidence focusing on vulnerable groups, such as pregnant women. This scoping review aims to provide an overview of the differences in self-medication prevalence and study characteristics among different groups, while identifying gaps in the literature.</p><p><strong>Methods: </strong>A literature search was performed in PubMed and Web of Science, including articles published in the last 10 years for the pregnant women group (PWG) and the general population group (GPG). Data on study design, self-medication prevalence, medications used, and other variables were collected, tabulated, and summarized.</p><p><strong>Results: </strong>From 2888 screened articles, 75 were considered including 108,559 individuals. The self-medication (SM) in the PWG ranged from 2.6 to 72.4% and most studies had an SM prevalence between 21 and 50% and in the GPG, 32 from 50 studies had a SM prevalence higher than 50%. The reviewed studies varied considerably in methodology, requiring careful interpretation. While most of the studies assessed self-medication during the entire pregnancy, self-medication definition was often inconsistent between studies. Acetaminophen was the most used medication and headache was the most frequent symptom leading to self-medication initiation in the PWG.</p><p><strong>Conclusions: </strong>Self-medication among pregnant women showed a lower prevalence when compared to the general population. The medications used and symptoms reported were similar between groups. However, methodological differences must be carefully considered. Pregnant women should carefully follow their physicians' advice before initiating self-medication to avoid preventable maternal and fetal adverse effects.</p>","PeriodicalId":74699,"journal":{"name":"Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia","volume":"46 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical, histopathological and immunohistochemical analysis of vulvar squamous cell carcinoma.","authors":"Lorenza Bridi Todeschini, Rita de Cássia Sant'Anna Alves, Adriana Vial Roehe","doi":"10.61622/rbgo/2024rbgo91","DOIUrl":"10.61622/rbgo/2024rbgo91","url":null,"abstract":"<p><strong>Objective: </strong>The average age of patients with vulvar squamous cell carcinoma (SCC) has been reported to have declined. Human papilloma virus (HPV)-related lesions have been shown to be associated with the expression of the immunohistochemical (IHC) marker p16. Non-HPV-related tumors have been characterized by p53 abnormal expression and PDL1 expression. We aimed to evaluate the correlation between these markers and vulvar SCC and to relate it to the clinical and pathological characteristics.</p><p><strong>Methods: </strong>Histopathologic assessments and IHC analyses of p16, p53, and PDL1 were performed in 41 samples of vulvar SCC collected between 2016 and 2021. The data were correlated with clinical and pathological characteristics of the patients.</p><p><strong>Results: </strong>The mean age of the patients was 72.1 years. Positive p16 and PDL1 staining was detected in 24.4% and 17.1% of the samples, respectively. p53 expression was negative in 19.5% of the samples, whereas it was overexpressed in 24.4%. p16-positive tumors showed a smaller depth of invasion (DOI) (p = 0.014), while tumors with p53 abnormal expression showed greater DOI (p = 0.041). PDL1 expression was correlated with increased number of inflammatory cells (p = 0.055). In addition, lesions with lymphovascular space invasion were p16-negative.</p><p><strong>Conclusion: </strong>In our sample, regarding to the SCC incidence the patients' mean age did not change. The expression of p16 was inversely correlated with p53 results. Tumors with p53 abnormal expression and absence of p16 showed a greater DOI. Our data suggest an association between PDL1 expression and increased inflammatory infiltrates in vulvar SCC.</p>","PeriodicalId":74699,"journal":{"name":"Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia","volume":"46 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic inflammatory indices as a non-invasive grading modality for endometriosis: a comparative study versus exploratory laparoscopy.","authors":"Ahmed Sabra Ibrahim Mohammed Sabra, Shreen Naguib Aboelezz Moselhy, Ahmed Kasem Mohamed Zain Eldin","doi":"10.61622/rbgo/2024rbgo84","DOIUrl":"10.61622/rbgo/2024rbgo84","url":null,"abstract":"<p><strong>Objective: </strong>Included evaluation of the possibility of using the systemic inflammatory indices for preoperative screening for the presence and severity of endometriosis (EM) in comparison to the findings of the exploratory laparoscopy.</p><p><strong>Methods: </strong>88 women with clinical manifestations suggestive of EM were evaluated clinically and by US and gave blood samples for estimation of serum cancer antigen-125 (CA125), platelet and total and differential leucocytic counts for calculation of inflammatory indices; the Systemic Immune-Inflammation index, the Systemic Inflammation Response Index (SIRI), the Neutrophil-Lymphocyte ratio (NLR), the Neutrophil-Monocyte ratio, the Neutrophil-Platelet ratio and the Platelet-Lymphocyte ratio. Then, patients were prepared to undergo laparoscopy for diagnosis and staging.</p><p><strong>Results: </strong>Laparoscopy detected EM lesions in 63 patients; 27 of stage I-II and 36 of stage III-IV. Positive laparoscopy showed significant relation with US grading, high serum CA125 levels, platelet and inflammatory cell counts and indices. Statistical analyses defined high SIRI and NLR as the significant predictors for positive laparoscopy and high serum CA125 and NLR as the most significant predictors for severe EM (stage III-IV) on laparoscopy.</p><p><strong>Conclusion: </strong>The intimate relation between EM and inflammation was reflected systematically as high levels of blood cellular components, but indices related to neutrophil especially NLR and SIRI showed highly significant relation to the presence and severity of EM and might be used as routine, cheap and non-invasive screening test before exploratory laparoscopy to guide the decision-making.</p>","PeriodicalId":74699,"journal":{"name":"Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia","volume":"46 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and factors associated with non-alcoholic fatty liver disease among women with polycystic ovary syndrome.","authors":"Maria Elisa Franciscatto, Juliana Bosso Taniguchi, Raquel Wohlenberg, Isadora Luísa Riedi, Karen Oppermann","doi":"10.61622/rbgo/2024rbgo81","DOIUrl":"10.61622/rbgo/2024rbgo81","url":null,"abstract":"<p><strong>Objective: </strong>To verify the prevalence and factors associated with Non-Alcoholic Fatty Liver Disease (NAFLD) among women with Polycystic Ovary Syndrome (PCOS).</p><p><strong>Methods: </strong>A cross-sectional study was conducted with 53 patients with PCOS. The diagnosis of PCOS followed the Rotterdam criteria. The diagnosis of NAFLD was made through US showing hepatic steatosis, excluding significant alcohol consumption and chronic liver disease. The following variables were compared between the groups of women with and without NAFLD: age, race, anthropometric data, blood pressure levels, liver enzymes, glycemic and lipid profiles, total testosterone, presence of hirsutism, and metabolic syndrome (MS). Variables were compared between the groups using T-test, Mann-Whitney, and Chi-square tests.</p><p><strong>Results: </strong>Among 53 patients with PCOS, 50.9% had NAFLD. The NAFLD group had higher weight (p=0.003), BMI (p=0.001), waist circumference (p≤0.001), fasting glucose (p=0.021), HbA1C% (p=0.028), triglycerides (p=0.023), AST (p=0.004), ALT (p=0.001), higher prevalence of MS (p=0.004), and lower levels of HDL cholesterol (p=0.043). The other variables did not differ between the groups. Both groups were predominantly of caucasian race, and there was no significant difference in age.</p><p><strong>Conclusion: </strong>The prevalence of NAFLD among patients with PCOS was 50.9%. Metabolic and hepatic enzyme abnormalities were more prevalent in this group compared to the group without the disease. Obesity tripled the prevalence of NAFLD.</p>","PeriodicalId":74699,"journal":{"name":"Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia","volume":"46 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: Effects of COVID-19 on human placentas in the second and third trimester.","authors":"Nayara Ribeiro Máximo de Almeida, Mateus Augusto Felix de Melo, Pâmela Marillac Rodrigues Feijó de Melo, Julio Martinez Santos, Johnnatas Mikael Lopes","doi":"10.61622/rbgo/2024rbgo88","DOIUrl":"10.61622/rbgo/2024rbgo88","url":null,"abstract":"","PeriodicalId":74699,"journal":{"name":"Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia","volume":"46 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Female genital tract microbiome: the influence of probiotics on assisted reproduction.","authors":"Ana Sofia Almeida Santana, Ana Margarida Póvoa","doi":"10.61622/rbgo/2024rbgo82","DOIUrl":"10.61622/rbgo/2024rbgo82","url":null,"abstract":"<p><p>Assisted reproductive technology (ART) has been evolving since 1978, with the number of techniques performed increasing over the years. Despite continued advances, some couples continue to have difficulties getting pregnant, and it has recently been considered that the microbiome of the female genital tract (FGT) may influence embryo implantation and the establishment of pregnancy. This review aims to evaluate the role of probiotics on reproductive outcomes in infertile women on ART. A search throughout medical databases was performed, and six articles met the criteria. Five studies showed improvements in pregnancy rates, with only one demonstrating statistical significance. One article showed no improvement but reported a statistically significant reduction in the miscarriage rate in the probiotic group. Further research is needed to evaluate the true potential of probiotics, namely to assess whether they effectively modulate the FGT microbiome and if these changes are maintained over time.</p>","PeriodicalId":74699,"journal":{"name":"Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia","volume":"46 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: Effect of combined training on body image, body composition and functional capacity in patients with breast cancer: controlled clinical trial.","authors":"Piyush Bharadwaj, Divya Khati, Simran Sunil Khutarkar, Sweta Verma","doi":"10.61622/rbgo/2024rbgo96","DOIUrl":"10.61622/rbgo/2024rbgo96","url":null,"abstract":"","PeriodicalId":74699,"journal":{"name":"Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia","volume":"46 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metformin versus insulin in gestational diabetes mellitus: a systematic review.","authors":"Giovanna Noronha Berti, Igor Gutschov Oviedo Garcia, João Pedro Ruas Floriano de Toledo, Júlia Rodrigues Tatemoto, Lais Watanabe Marino, Mariana de Medeiros Legori, Sérgio Floriano de Toledo","doi":"10.61622/rbgo/2024rbgo89","DOIUrl":"10.61622/rbgo/2024rbgo89","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study is to assess the use of metformin with or without insulin for the treatment of Gestational Diabetes Mellitus compared to insulin alone.</p><p><strong>Data sources: </strong>This article consists of a systematic review of randomized clinical trials. The searches were carried out on MEDLINE including 7 studies, between 2010 to 2021.</p><p><strong>Study selection: </strong>Randomized clinical trials comparing metformin and insulin written in English, Spanish or Portuguese, with no time limit, were included.</p><p><strong>Data collection: </strong>Data was extracted from all the 7 articles and compared statistically when possible. Whenever data was not available or couldn't be statistically compared, the main results were described in detail.</p><p><strong>Data synthesis: </strong>Insulin alone is not superior than metformin with or without insulin on gestational diabetes mellitus.</p><p><strong>Conclusion: </strong>There is a potential viability of using metformin as an alternative compared to insulin alone in the treatment of Gestational Diabetes Mellitus. However, all assessed outcomes have a very low level of certainty of evidence and more studies are necessary to support these findings.</p>","PeriodicalId":74699,"journal":{"name":"Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia","volume":"46 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}